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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_884_Библиотеки_им_академика_М_И_Перельмана
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Fig. 5.24
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.25
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5 Eyelid Surgery – Blepharoplasty
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Excision of the Musculocutaneous Flap (Fig. 5.26)
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The surgeon places the two-pronged hook on the upper edge of the
incision and pulls it upward at a 90° angle. Meanwhile, the assisting
surgeon continues to smooth the skin of the lower eyelid gently downward until it is taut.
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The surgeon now dissects the flap consisting of the eyelid skin and the
orbicular muscle along the markings. The fat deposits located below the
orbital septum are soon visible. If the surgeon is working in the correct
layer, this dissection proceeds with almost no loss of blood.
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The musculocutaneous flap is detached up to the infraorbital margin,
which can be easily palpated.
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Fig. 5.26
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5 Eyelid Surgery – Blepharoplasty
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5 Eyelid Surgery – Blepharoplasty
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䊏
To obtain an optimal overview of the surgical area, the surgeon places a
4/0 Prolene holding suture through the upper incision edge; this suture
is then fastened to the hairline under tension with a mosquito hook.
The assisting surgeon places a long two-pronged hook on the musculocutaneous flap in order to keep the edges of the area to be dissected far
apart. (Fig. 5.27)
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The surgeon can now expose the medial, intermediate, and lateral fat
pads, which are the actual cause of the “baggy” eyelids, by blun tl y
dissecting them with the assistance of a moist flattened compress.
(Fig. 5.28)
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Fig. 5.27
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.28
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Medial, Intermediate, and Lateral Lipectomy (Fig. 5.29–5.32)
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Thesurgeonfirstremovesthemedialfatdeposits.
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After carefully splitting the orbital septum pointwise, the surgeon
exerts light pressure on the eyeball; the fat pad is thereby pushed outward and can now be dissected. (Fig. 5.30)
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Fig. 5.29
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.30
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䊏
The base of the fat pad is grasped with a mosquito hook. With the hook
left in place, the fat pad is excised with the delicate eyelid scissors.
(Fig. 5.31)
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With the hook still in place, the stump of the fat pad must be coagulated with the delicate electrocoagulation forceps to prevent hemorrhage into the eyeball.
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For safety reasons, the fatty stump is now grasped below the level of the
mosquito hook with delicate surgical tweezers guided with the left
hand. The hook is now removed and the fatty stump is coagulated
again above the surgical tweezers. The stump can now be released; it
slips back immediately under the orbital septum.
(Fig. 5.32)
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Fig. 5.31
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5 Eyelid Surgery – Blepharoplasty
Fig. 5.32
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䊏
Medial and lateral lipectomy is now performed with the same technique. It is important to split the orbital septum only pointwise. Care
should be taken, moreover, that the caudal margin of the inferior tarsal
muscle and the infraorbital margin constitute the cranial and caudal
boundaries, respectively, of the lipectomy area.
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Finally, the surgeon exerts slight pressure on the eyeball to make sure
that the fat has been homogeneously removed.
(Fig. 5.33)
Removal of a Muscular Strip From the Orbicular Muscle of the Eye
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Using the delicate surgical tweezers, the surgeon now grasps the cranial
margin of the orbicular muscle of the eye located beneath the lower
edge of the cutaneous incision and resects a 3–5 mm wide muscular
strip. At the same time, this step paves the way for the planned cutaneous resection by preventing unevenness and thickening on the incision
surface. In addition, this muscle resection exerts a tightening effect.
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This is followed by repeated trimming of the wound edges and hemostasis. The latter procedure is performed with the delicate electrocoagulation forceps and a small moist flattened compress.
(Fig. 5.34)
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